A Citizen's Guide to Indiana

The headline – “Hospital: Solve bigger problem // Medicare payment system is broken, Reid chief says”

From this headline, I took away that the hospital executive said that Medicare was the problem. What he (Reid Memorial Hospital President Craig Kinyon) actually said was:

KINYON: We have gone from trying to fix the uninsured, to expanding Medicare, and we still have a broken Medicare system of reimbursement. Uninsured (bad debt and charity care) are about $36 million a year at Reid. Health care reform costs to fix this nationally are about $1 trillion. Medicare and Medicaid write-offs, NOT paid by Medicare/Medicaid and/or the patient are over $180 million per year.

There is NO mention of relief for this bigger and out of hand problem.

For the insured patient, 47 cents on every dollar we charge goes to pay for Medicare/Medicaid, bad debt/charity writeoffs.

So, what he actually said, apparently, was that when lumped together Medicare, Medicaid, bad debt, and charity adds $0.47 to the cost of privately insured patients. We don’t know whether Medicare is a substantial factor in this write-up. (It’s kind of like the joke about how, when Bill Gates walks into a bar, the average patron is worth millions.) If, for example, Medicare was a small part of the problem in the equation, and the uninsured were a big part of the problem, then moving a bunch of the patients from the “uninsured” column to the “Medicare” column, that $0.47 would go down.

And if Medicare is such a problem, I guess I don’t understand why every medical provider doesn’t opt out, charge the remaining patients 1/3 less, and corner the market.

For some reason, the Reel Big Fish song, “Sell Out” is going through my head.

Sell out, with me oh yea, sell out, with me tonight
Record company’s gonna give me lots of money
and everything’s gonna be (all right).

Matt Taibbi notes that the evidence suggests single payer as the solution to most of the bigger problems with our health care system but that was off the table from the start, for some reason. Apparently the Democrats thought they could start in the middle and negotiate down from there. In any case, he further notes that one of the biggest complaints about the system is bureaucracy and paperwork. The proposed compromise seems to do exactly nothing about that.

[T]he name of this game is passing something the Obama administration can call health care while preserving massive subsidies to the insurance and pharmaceutical industries. In that regard, the government under the new plan will continue to be barred from negotiating bulk rates for pharma purchases for Medicare, while insurance companies won’t have to trim profits or paperwork to compete with a real public option. The Obama administration also recently reversed itself on yet another campaign promise and decided to come out against plans to allow pharma purchases from Canada, further protecting the pharma industry.

So the old system of inefficient bureaucracies and artificially high prices has basically been completely protected.
. . .
If expanding Medicare is good for people aged 55 and up, why isn’t it good for everybody? Why isn’t it a good idea to provide cheaper insurance for people in their preventive care years, so that they cost Medicare less as they do get older?
. . .
This isn’t a health care strategy, it’s a big baby that’s been hacked up into parts and fed in descending size order to the administration’s weightiest political lobbies.

Angela Mapes Turner, writing for the Fort Wayne Journal Gazette, has an article reporting that Indiana has the third lowest threshold in the country for taxing low income families.

The state’s income tax threshold last year for a two-parent family of four – the lowest income at which a family has state income tax liability – was $15,500, third lowest in the nation.

A two-parent family of four at the federal poverty line, or earning $22,017, owed $263 in Indiana income tax last year. That same family would have owed $214 in Illinois, $168 in Ohio and $89 in Kentucky, according to the report.

Alabama taxes low-income families the heaviest. The system starts to look dysfunctional in those situations where you tax their income on one hand but then turn around and provide subsidies on the other, through food stamps, medicaid, TANF, or whatever.

The 7th Circuit has issued an opinion upholding the district court’s grant of summary judgment dismissing the claims of Lisa Coffey and James Patterson, former editorial writers for the Indy Star, alleging that they had been dismissed because of their religious beliefs. (See, e.g., this report from a Christian newspaper characterizing the suit as a firing of Christians by homosexual management.)

The 7th Circuit, in a 3-0 ruling by a panel consisting of Circuit Court Judges Cudahy, Flaum, and Sykes, characterized Coffey and Patterson’s claims as being that the Star engaged in systematic discrimination against “traditional Christians,” opposed public or workplace expressions of religion and discriminated against those who were opposed to homosexual conduct as a matter of their religion.

The plaintiffs claim that after Ryerson became editor, the Star published “hordes of news articles” designed to portray homosexuality in a positive light, “softened” its editorial opposition to same sex marriage, promoted employees who were homosexuals or “homosexual sympathizers,” sought to purge the news and editorial operations of the paper of “traditional Christians,” and otherwise exhibited animus toward Christians who opposed homosexual conduct.

Initially, the 7th Circuit noted that its review was constrained by the procedural history of the factual allegations in the summary judgment motion. First, the district court rejected a lot of Coffey and Patterson’s identification of material facts in dispute because it was rife with argument, in violation of the local rules. Furthermore, their affidavits were rejected where the affidavits contradicted their deposition testimony. You are supposed to identify facts in dispute as objectively as possible, saving your argument for a later part of the brief. Additionally, courts will not allow self-serving affidavit testimony to trump contradictory deposition testimony without a good explanation for the contradiction. This resulted in the courts working on the law based mostly on the Indy Star’s characterization of the facts.

Coffey was in the editorial department at the Star who described herself as a “traditional Christian” who regards homosexuality as sinful. This apparently prompted her to write an opinion column against the Supreme Court’s decision in Lawrence v. Texas which editor Dennis Ryerson rejected as unsuitable for publication due to its graphic description of anal sex. This led to several e-mail exchanges, at least one of which Ryerson regarded as religious proselytization in violation of the Star’s policy. The Star also believed Coffey was violating its policy against working overtime without permission. Certain administrative changes resulted in a reduction in Coffey’s hours. She was offered a choice between part time editorial work or full time news work. Rather than take the full time news position, she resigned.

James Patterson was also an editorial writer who described himself as a “traditional Christian” and regarded homosexuality as sinful. His work apparently required more editing than the typical editorial writer. The Court noted that: Patterson endorsed “Vernon Smith” when he meant “Vernon Brown.” He described JFK’s assassination as 30 years earlier instead of 40 years earlier. He wrote of Gov. O’Bannon’s acceptance of a resignation when Gov. O’Bannon had been dead for five months.

With respect to religion:

In 2003, after the start of the Iraq war, Patterson submitted an editorial asking the newspaper’s readers to pray for American troops. Neal revised the editorial slightly and added a prayer at the end, and the editorial ran in the newspaper on March 20, 2003. After its publication, however, Ryerson—who had just joined the Star—told Neal that he was uncomfortable with an editorial telling readers to engage in religious practices. Patterson claims that after this point if he submitted any religious-based opinion pieces that differed from Ryerson’s viewpoint, the articles would not be published, although he does not say how often this occurred.

After placing Patterson on an improvement plan, the Star kept him at the “written warning” discipline level. That level escalated when Patterson erroneously claimed that a proposed bond issue would cause a property tax increase and endorsed an AirTran bid for ATA Airlines without verifying the matter with anyone from AirTran, ATA, or Southwest, the competing bidder. This raised the DEFCON to “final written warning.” Nevertheless, editorials continued to get submitted with misspelled names and incorrect dates, resulting in Patterson’s termination.

The [district] court then concluded that neither plaintiff had established a prima facie case of discrimination under any theory and in the alternative held there was no evidence that the Star’s employment actions against Coffey or Patterson were pretext for discrimination. The court also rejected Patterson’s retaliation claim. Finally, the court held that there was no evidence to support the plaintiffs’ claims for negligent infliction of emotional distress. Accordingly, the court entered summary judgment in favor of the Star.

The Star points out ways in which it is obviously not anti-Christian. Many of its top managers are Christians, it has editorialized against same sex marriage, it has opposed the ACLU’s lawsuit opposing legislative prayer, and it’s front page name plate prominently displays a Bible verse.

Coffey’s claim, the 7th Circuit held, fails because she cannot show that she met the Star’s legitimate performance expectations and she cannot show that a similarly situated employee who did not share her religious beliefs was treated more favorably. Patterson’s claims were also rejected because he couldn’t show that he was meeting the Star’s legitimate performance expectations.

Not sure if it’s just luck of the draw or what, but scanning the headlines this morning, I see three cases involving people falsely reporting crimes to the police:

#The Star Press has an AP story about a New Jersey woman who lied about being gang raped, resulting in the conviction of a man who ended up serving three years of a twenty year sentence.

#Seth Slabaugh, also writing for the Star Press, has an article about a Ball State student who lied about being attacked by a man as she walked back to her dorm.

#Holly Abrams, writing for the Fort Wayne Journal Gazette, has a story about an Ohio man who faked an attack on himself, claiming he’d been hit in the head with a bottle and shot in the leg.

I’m not sure if these folks are just desperate for attention or what. Our perceptions of risk are skewed enough by the emphasis on real crime that we see in the news. We don’t need people faking attacks to exacerbate the problem.

Taibbi has a post up about Palin’s recent dive into the shallow end of the Birther pool. But, what caught my attention was his discussion of what “The Left” meant in today’s politics; in particular, the labeling of Howard Dean as “too far left.” I was (and am) a huge Dean supporter. I never could figure out what it was about his policies which were supposed to be all that “left.” As a Governor, he had more or less centrist policies. He opposed the War in Iraq, to be sure; but that was (and is) good policy. But it’s not about policies. It’s never about policies. It’s about Villager cultural norms.

In the modern United States, “left” doesn’t have any concrete meaning that I can see, but that doesn’t mean we don’t know what it means – it’s like pornography, people know it when they see it.

In 2004, on the Dean campaign plane, after seeing reporters throw the words “left” and “liberal” with Dean in a way that I didn’t really understand given the governor’s history, I polled the press corps on what its definition of “left” was. I got very few answers. While it was well understood that Howard Dean was “left” (and not just “left” but “too left” to win the White House, according to many reporters) no one could really say which of his policy ideas qualified him for that title.

In the end it was pretty clear to me anyway that “left” was basically a shorthand term for “pointy-headed weenie dissident.” Except for his stance on the war, Dean’s policies were much less traditionally “liberal” than, say, those of John Kerry — but Kerry made up for it by being much more full of shit than Dean.

Kerry was willing to say anything to get elected; he was willing to toe the Democratic Party’s absurdly vacillating non-stance on the war (We like war in general, we’re not wimps, but Bush should have invaded on a Tuesday, not a Thursday!), he nearly killed himself trying to give the press goofy photo-ops of the candidate playing manly sports like football and baseball, and was even willing to pose in a duck-hunting costume carrying a rifle.

Kerry’s willingness to jump through all the usual idiotic hoops set out for him by the political media made him less “left” among those in the press corps than an economic centrist governor from Vermont who was openly critical of the media’s war coverage and did not even have a Nerf ball on his plane. Which is normal and somehow made sense to all of us. If you scratch the surface of “left” you’ll find that it has a lot more to do with attitudes and cultural markers relative to the bourgeois norm than it does to do with political beliefs, ideas about the role of government, taxes, and so on.

It’s much easier to figure out who’s “left” and who isn’t using cultural litmus tests than it is using position papers. What’s the left position on monetary policy? I have no idea. What’s the left’s position on American Idol? Easy: it rolls its eyes.